effects of chemotherapy on the brain in women with newly diagnosed early-stage breast cancer

Conditions: Breast Cancer; Chemotherapeutic Agent Toxicity; Cognitive/Functional Effects; Fatigue; Long-term Effects Secondary to Cancer Therapy in Adults; Neurotoxicity; Psychosocial Effects of Cancer and Its Treatment

Summary: rationale: gathering information over time from laboratory tests, imaging scans, and assessment tests may help doctors learn more about the side effects of chemotherapy and plan the best treatment. purpose: this clinical trial is studying the effects of chemotherapy on the brain in women with newly diagnosed early-stage breast cancer.

objectives: primary * to prospectively evaluate the acute (1 month after chemotherapy) and relatively long-term (18 months after chemotherapy) effects of standard-dose chemotherapy and/or hormonal therapy with aromatase inhibition on brain function using positron emission tomography (pet) and the glucose metabolism tracer fludeoxyglucose f 18 in women with newly diagnosed, early stage breast cancer. secondary * to evaluate the acute and relatively long-term effects of chemotherapy and/or hormonal therapy on mri measurements of hippocampal volume, cortical grey matter volume, white matter signal hyperintensities, ventricular volume, and whole brain volume in these patients. * to evaluate the acute and relatively long-term effects of chemotherapy and/or hormonal therapy with aromatase inhibition on cognitive function in these patients. * to explore the characteristics of these patients that renders them more vulnerable to chemotherapy and/or estrogen suppression-induced cognitive decline. outline: patients are stratified according to planned adjuvant chemotherapy (chemotherapy and hormonal therapy vs hormonal therapy vs chemotherapy vs no therapy) and the hormone receptor status (positive vs negative). patients (groups a-c) undergo bioavailable estradiol measurements, pet scans, and mri scans at baseline and 1 and 18 months after treatment. patients also undergo cognitive, neuropsychological, sociodemographic, and quality of life assessments using a battery of study tests and questionnaires at baseline and at 1, 9, and 18 months after treatment. group d participants (controls) undergo the same testing at equivalent intervals.

Eligibility criteria:
disease characteristics: * diagnosis of breast cancer, meeting 1 of the following criteria: * group a * stage i, ii, or iii invasive disease * hormone receptor-positive disease * planned adjuvant chemotherapy including an anthracycline and taxane using either dose-dense or docetaxel, doxorubicin hydrochloride, and cyclophosphamide (tac) regimens with or without trastuzumab (herceptin®) for 4 months; docetaxel and cyclophosphamide (tc) with or without trastuzumab for 3 months; doxorubicin hydrochloride and cyclophosphamide (ac) for 3 months; or doxorubicin hydrochloride, carboplatin, and trastuzumab (tch) for 4 months (trastuzumab may be given for 1 year and is not considered chemotherapy for the purpose of this study) * planned treatment with adjuvant aromatase inhibitors (ai) for 5 years * group b * stage i or ii invasive disease * planned treatment with adjuvant ai with or without radiotherapy * group c * stage i, ii, or iii disease * hormone-receptor negative * planned adjuvant chemotherapy as in group a * no treatment with ai planned * group d * healthy controls free of any major medical or psychiatric disorders * not taking prescription medications, including hormone-replacement therapy, or other substances that might influence performance on neuropsychological tests * balanced with the patient groups on age, education, ethnicity, and sociodemographic background patient characteristics: * no history of psychiatric illness other than minor depression * no history of psychiatric illness other than minor depression in immediate family members * no history of neurologic disease * no history of drug or alcohol abuse * no significant medical illness other than breast cancer * no heart pacemaker or metallic implants or particles in the body * no heart rhythm disturbance * no claustrophobia * no prior serious head injury * no tattoos or permanent cosmetics * no unremovable body jewelry * no cognitive impairment * able to read and speak english * no condition that compromises compliance with the objectives and procedures of this study, as judged by the principal investigator prior concurrent therapy: * see disease characteristics * no prior chemotherapy, cns radiotherapy, or intrathecal therapy * premenopausal women receiving aromatase inhibitors must also be receiving ovarian suppression * no concurrent narcotics or major antipsychotic medications that may impair cognition

Keywords: cognitive/functional effects fatigue long-term effects secondary to cancer therapy in adults psychosocial effects of cancer and its treatment chemotherapeutic agent toxicity neurotoxicity stage ia breast cancer stage ib breast cancer stage ii breast cancer stage iiia breast cancer stage iiib breast cancer stage iiic breast cancer estrogen receptor-negative breast cancer estrogen receptor-positive breast cancer progesterone receptor-negative breast cancer progesterone receptor-positive breast cancer